Surgery center increases payments by 47%
Executive Summary
A surgery center increased its collections 47% from a four-month period in 2012 to the same period in 2013 by collecting copays and deductibles up front. Less than 1% of patients have cancelled.
• Having buy-in from the surgeons is the first and most important step. Also get buy-in from your staff.
• Send a letter to patients that outlines the process and tells them to expect a telephone call from the center in which they will be asked to pay upfront. Ask most patients to pay via credit card on the phone.
• Set a collection goal, and give small prizes.
How would you like to improve your "over-the-desk," prior-to-date-of service payments by 47%? What about collecting the money upfront without going through the collection process? Longmont (CO) Surgery Center reached these accomplishments between June-September 2012 and June-September 2013 by collecting copays and deductibles upfront.
Between June and September 2012, the center collected $245,392. One year later, in the same time period, it collected $360,057, an increase of $114,665. Angie Blankinship, BSN, CASC, administrator at the center, shared her success at the recent annual meeting of the Ambulatory Surgery Center Association (ASCA). Consider her suggestions:
• Obtain buy-in from your surgeons, your staff, and the physician office staff.
"Having buy-in from the surgeons is not only the first step, but the most important," Blankinship says.
She presented a business plan to the board of directors that included the financial gain, decrease in accounts receivable (AR), increased revenue, and decrease in accounts that are sent to collections. She also discussed the downside. "I wanted to start there because I felt that once I showed the numbers and outcomes, they’d agree without hearing what this decision may mean to their patients, their office nurses, and the staff at the center," Blankinship says.
For example, office nurses might think the surgery center staff members don’t understand billing or how hard they work communicating with their patients. Or they might ask, "Why do you make them pay?" "I often feel that I should answer this by asking how Wal-Mart or Safeway would feel about letting customers take products from their store with a, "I’ll pay that.."
Surgeons need to know how to respond to their staff, although many simply told the staff to call Blankinship.
You also need your staff members to be on board, so obtain their input she says. "They’re the experts at what they do every day," Blankinship says.
• Communicate with patients.
Communication is the most important beginning, middle and end of every process, Blankinship says. She sends a welcome letter to every patient. [The letter is included with the online issue of Same-Day Surgery available at www.reliasmedia.com. For assistance, contact customer service at (800) 688-2421 or [email protected].] It gave her a venue to discuss common patient complaints, such as the telephone calls made by the staff.
She included a paragraph regarding their process with collecting money prior to date of service. Blankinship makes rounds on patients and staff four times daily, and she says patients have commented that the letter helped them to understand the process.
So that patients are prepared to pay their fees, as outlined in their contract with the insurance company, Blankinship often refers patients to that contract. "I’ve had several patients call me back and thank me as they hadn’t realized how the contract read and didn’t understand the coverage they were paying for," she says.
Some patients complain to the surgeons about being asked for money up front, but less than 1% of patients have cancelled. Additionally, if something unexpected comes up with the patient, Blankinship has asked staff to complete an occurrence form. (A copy of the form is available with the online issue of Same-Day Surgery.) The form helps the surgery center in its process improvements. "It’s not punitive," Blankinship says. "I tell them nothing is too big or too small for the report to be completed."
• Give staff the tools they need to do their job, and stage your staff’s positions so that they will succeed.
The center staff learned what to do by trial and error. When we first started we were only calling the insurance company, getting the correct amounts, and then we were calling the patient two-days out or even the day before," Blankinship says. "We weren’t very popular with the patients, and the staff was frustrated."
The person who was making the calls was the bookkeeper, who wasn’t accustomed to patient contact. "She struggled with being empathetic and establishing a relationship with the patients," Blankinship says. "Our current secretary [who makes the calls] wears a headset, is totally comfortable talking on the phone, can emphasize, understands, develops the relationship, but yet simply stands her ground without being demanding. Sounds a lot like a good salesman, doesn’t it?"
The business office staff now owns the process, Blankinship says. She gives this example: A patient came in and had multiple notes in the system regarding telephone calls to him explaining the collection process. "He checks in and denies he’s heard from anyone," Blankinship says. "My staff has handled our process so many time successfully; they, too, understand that there are those rare cases when you know in your heart that you’re not going to win," she says.
The staff members decided to accept the amount that he felt comfortable paying and bill for the balance. "They didn’t have to text me to ask," Blankinship says. They knew what to do "and made an uncomfortable situation as smooth as it could be." (See more on how the process works, p. 81.)
Set a collection goal that takes into account case mix, volume for the month, and dollars spent. Give small prizes such as gift cards, pedicures, and jewelry, Blankinship advises. "They respond more to that than graphics, but I still show them information," she says.
Humor also helps. An eye patient was coming in for a cornea procedure, He called and asked if his procedure was half price because he was getting a "used cornea." "This made us smile and giggle for an entire week," Blankinship says. "We do seem to have some fun every day, and isn’t that as important as succeeding at our jobs?" (For information about how another practice collects copays, go to http://bit.ly/1mPEj2P. For more coverage of the ASCA meeting, see "Your employee might be a drug or alcohol abuser — What do you do?" on our Hospital Report blog at http://bit.ly/1l0PViV.)
- Angie Blankinship, BSN, CASC, administrator at Longmont (CO) Surgery Center. Work telephone: (303) 682-0375. Email: [email protected].
